Organization
VIDALIA SURGICAL ASSOCIATES, LLC
Active
Parent organization
SOUTHEAST REGIONAL CARE CORPORATION
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHEAST REGIONAL CARE CORPORATION
Authorized official
TONY M OSTEEN (CFO)
(912) 538-5314
Entity
Organization
Contact information
Practice address
1811 EDWINA DR, VIDALIA, GA 30474-8963
(912) 538-9977
Mailing address
PO BOX 407, VIDALIA, GA 30475-0407
(912) 538-9977
(912) 538-0770
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
192640864A
—
GA
Enumeration date
10/12/2007
Last updated
07/10/2020
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